The Epidemic of Perfectionism in Silicon Valley

Searching for answers in a world overrun by perfectionism.

In 2015, my life looked textbook-charmed. I’d lived in San Francisco for 12 years — long enough to understand its ups and downs — and worked in tech nearly as long. I had a thoughtful, handsome husband and a wise, funny, five-year-old daughter.

But this is what my life felt like:

Almost daily migraines, crippling neck and shoulder pain, and a nauseated stomach that sometimes forced me off the bus to keep me from fainting.

I’d long ago given up on finding a cause for these pains, so I went to my annual neurologist appointment ready for my regular dose of confused irresolution. Instead, shockingly, she diagnosed me with generalized anxiety disorder, and my life changed on the spot.

An Elusive Epidemic

Generalized anxiety is an umbrella term, meaning that there are lots of different types of people to be found under there when it rains. 

The statistics shared on ADAA suggest that 6.8 million Americans, or a little over 3% of the population, has generalized anxiety disorder. (I think that’s massively understated, incidentally).

Another skepticism (settle in, cause I’m full of them) has to do with just what GAD is. “Excessive worry,” as the disorder’s most common descriptor, was problematic for me, because for 39 years, I didn’t consider myself a worrier.

I was an overthinker with migraines.

And since I never used the words or mindset that the health industry used, I found very few examples that rang true when I searched for more information about generalized anxiety. In person and online, though, I met tons of people who were, in fact, just like me: men and women experiencing physical pain resulting from perfectionism, fear of failure, and overthinking.

The disconnect between how people talk about anxiety and what anxiety actually feels like is the engine that drives me to write about this phenomenon. Thanks to my diagnosis, what was once invisible now has shape, and I understand the world around me differently.

I hear the hum of the ambient complaints in a new way.

Was My Experience Unusual? 

A few months after going on anti-anxiety medication, I went back to my neurologist at UCSF and explained that my once-daily headaches were now down to one per month. I was grateful. I was also curious to know if my experience was unusual. From what I could tell, it seemed surprisingly common.

But—cue the overthinking—maybe I was overestimating it. Like every good student of anxiety, I had memorized my list of cognitive biases. Was I overgeneralizing? Was my sense that people around me were experiencing physical pain as a result of perfectionism simply projecting my problem onto others?

Was I hearing only what fit my story?

An illustrated guide to cognitive biases, as seen in Business Insider.

My neurologist listened to my concerns and then replied, “This problem — the problem of perfectionism and anxiety — is getting bigger and bigger every day.”

She described seeing an average of three people a day suffering from some form of chronic physical pain who had one thing in common: perfectionism.

“It’s extremely common in the tech industry,” she said. “These people are very successful. They want to do everything right.”

She then said something that stayed with me. It’s a statement so clear, so unwavering, that I knew I needed to reckon with it (and still do): “One of the groups that has the hardest time seeing GAD in themselves is psychiatrists and psychologists.”

Where We Came From

In the past, if you had a physical problem, you’d visit a doctor.

If you were having a mental problem, you’d visit an office like this:

Treating symptoms meant sitting in a room with an expert, looking for answers together.

If your physical symptoms spring from your intense pursuit of perfectionism, however, this method is problematic. You can visit doctors of all stripes, and they won’t find anything physically wrong with you. Therapists may enjoy your confessional insights and wit as much as you enjoy sharing them—but they won’t help you when your back gives out again.

It's Up to You to Connect the Dots

Anxiety, though chemically and genetically influenced, is, at its most fundamental, a system of messages the body is trying to send the mind. It’s similar to an allergic reaction where the body overreacts to stimuli. In this case, the fear of losing control causes an adrenalin and cortisol rush in the body. Our minds work to avoid negative feelings (or the stimuli that caused it). Yet the effort of avoidance ends up creating more fear—and more overreaction. Doctors have long seen a connection between the physical pain that people feel and the emotions they are repressing.

For perfectionists, the mind is trying to tell itself the truth: “I can’t live up to my own expectations.” But inherent in the perfectionist problem is an inability to accept this reality. The mind deflects the message of impossible expectations and literally pushes it into the body.

My neighbor is an example of this. Let’s call him Shane. Shane is an artist and teacher who spends a lot of time worried about what other people think about him. His standards for work are extremely high.

He also has a lot of neck and back pain, sudden bouts of sweating, and dizziness. He takes 3–4 ibuprofen a night for “sore muscles.” He needs a whiskey to help him fall asleep.

He knows that he has anxiety, but hasn’t yet figured out how to listen to what his body is telling him, or how to address the pain.

When I learned about my generalized anxiety disorder, I started with the treatment path of medication (Lexapro, 10 mg every day), meditation (Headspace, 20 min every day), and communication (writing, talking, all the ways). Treating perfectionism meant I’ve been forced to stop comparing myself to other people, especially on social media. I’ve had to learn how to turn up the volume on my own voice of confidence and creativity. I did this by creating a project that looks at perfectionism from a bird’s eye view.

Helping Perfectionists Learn From Each Other

For over a year and a half, I’ve been working to create a place for perfectionists to meet and learn stress relieving techniques from each other. It’s called The Beautiful Voyager. 

My goal with the site was to create a space where it was OK to be imperfect. I threw my real, far-from-perfect self, out into the world for everyone to see, hoping that other people like me might find comfort and common cause in my struggle. It’s like training wheels for social interactions. As confidence builds, pain subsides.

The Only Map is Buried Deep

I used to think, "There's no map to understanding anxiety." But that's not true. There is a map. It's just that each person's is unique and buried deep inside of them. It takes a long time to navigate your own internal terrain. I created this site because it helps to have other navigators around during the map-hunting process.

If you or someone you love is experiencing symptoms like those on this list from my neurologist, take a closer look at how anxiety isn’t always what it seems.

• migraines
• dizziness
• nausea
• back pain
• neck pain
• tingling
• chest pressure
• palpitations
• light-headedness

This is one epidemic we can do something about, but we have to work together. So as you go out into the world, or deep into the world within, in search of the map you need, know that you’re not alone.

I’ll meet you there.

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Originally published on Heleo on October 6, 2016. Republished and updated on Bevoya.com on May 2, 2017.

A Curious Case of SIBO

FS is a Beekeeper in her free-time. FS has a high stress job. Who doesn't tho?

In writing the Beautiful Voyager, I dig into how stress affects our bodies, sharing the hard-won discoveries about my own lifelong migraines and nausea.

I've wondered how people in my life are struggling with confusing physical symptoms at any time. The journey to diagnosis can be an uphill and silent battle. Sometimes it's just a matter of getting lucky and reading a blog post at the right time.

To that end, I'm sharing a little Q&A with a friend of mine, who I'll call FS. After years of trying to figure out what was wrong with her, FS was diagnosed last year with SIBO.

SIBO's a confusing condition that mimics Irritable Bowel Syndrome in many cases. It's actually a result of a bacterial overgrowth in the lower intestine. When she first told me about it, it was the first time I had heard of SIBO. I immediately had a feeling it wouldn't be the last. Indeed, just last week another friend was diagnosed with it.

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MA: How long did you know something was wrong before you were diagnosed?

FS: A little over 3 years.

MA: What do you tell people when they ask what SIBO is?  

FS: I always tell them it's "digestive issues."

MA: Were you ever misdiagnosed?

FS: Yes, I was misdiagnosed with IBS. I don’t have IBS.

MA: Does anyone else you know have it?

FS: No, not by formal diagnosis. (Except the friend of yours you connected me to).

MA: It feels to me like SIBO is one of those things that a lot of people suddenly are finding out about. Has your doctor mentioned an uptick in cases?

FS: You can find articles and knowledge of SIBO only 6 or so years back on the internet.  It's something that doctors have started paying attention too the past couple years, and only GI specialists really know about it.  You’ll find that primary care docs and nurses don’t know about it, and as a result they misdiagnose it. You can be given medications that will actually make it worse.

MA: What do you have to do differently?

FS: I've had a full revamp of my diet and how I think about meals. It's helped.

MA: How are you feeling now?

FS: Still having symptoms but better, emotionally more so than physically, because I at least know it’s not just “stress." It’s a thing that I have and I'm dealing with it.

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I'd love to hear more from others who have successfully dealt with confusing physical issues and who are starting to make progress. What steps did you take? What got you feeling better?

Feeling better, in dance form

I Wish I Had Known That Amorphous Pain was Not a Given

This is what amorphous carbon looks like on a structural level. Seem familiar?

If there's one thing I wish I knew as a twenty-year-old, it's that migraines, nausea, and stiff necks didn't need to be a regular part of my life. I don't blame my doctors, asking me vague questions I couldn't answer. I was a crappy communicator when it came to describing what I felt. I didn't know how to sort and label the chronic pain that came at me from so many angles. I just chalked the whole ball of pain up to being a migraine person and tried to move on.

Here I am meeting my nephew for the first time. That's a huge scarf tied around my head in the attempt to kill a migraine.

But over time my headaches got worse. In my late 30s it was harder to ignore the impact on my life. I started seeing more doctors and tracking everything I experienced, meticulously noting how my hormone cycle intersected with my other symptoms. This was the point at which I finally started to articulate everything I was feeling. A neurologist was finally able to help by diagnosing me with Generalized Anxiety.

Why am I telling you this? I believe I am not alone on this terribly confusing path. In the time since I was diagnosed, I've talked to tens of people with similar symptoms who also didn't realize that anything could be done about it. They were like me: living with chronic pain, not knowing that anything could change. Simply talking with them has made a huge difference for me, and, as they've told me, for them. 

What do they have in common? They are people who have always thought deeply about things. They've frequently wondered if others ever feel the same way they did. They are often researchers, always looking for the answers. Their friends and family have told them not to think so much ever since they were little kids. They're sensitive and aware of the suffering of others. Another way to put it: at times, it feels like they get stuck in their heads. 

I explain to them that I think of these as the common traits of overthinkers. 

In response, they tend to either say, "Nah, that's not me," in which case, we move on to other topics, or their ears prick up. "That sounds familiar," they might say. "But what's wrong with overthinking, exactly?"

My response is always the same: If you aren't experiencing pain or adverse effects, there's nothing wrong with being an overthinker. But too often overthinking has an obsessive "got to figure things out" quality. As a BV* I know puts it, "In obsessing over figuring things out, you tend to neglect your priorities and what is important in your life."

Or, as a concrete litany of ifs: If your shoulders and neck are so tight that you need to take medicine for them every day. If you experience lightheadedness or dizziness regularly (or if you faint). If you have migraines that affect your ability to work. If you have nausea that makes it uncomfortable to travel or engage in other activities you love. If physical pain that's hard to pin down but reoccurring. If if if.

When again the person I'm speaking with starts to nod, I know that it's time for me to reassure them that they are far from alone. Others have felt--are feeling--this way. I tell them that life doesn't have to be like this. "You don't have to feel this crappy," I say.

On my 40th birthday AKA the day I finally started to realize that I didn't have to feel amorphously bad anymore.

For many of the people I've spoken with in the past year, this is the beginning of a new way of thinking. It's confusing and difficult to accept that it's your mind that can be hurting your body the way that it is, but for many of us, it's true.

"You don't have to feel amorphously bad anymore," I say. "There are many, many things you can do to feel better. But one of the biggest things can happen right now. It starts with realizing that you don't have to live this way."

I had a hard time figuring out what this post should focus on. Press play to listen to a great discussion I had about it beforehand on Anchor.

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*BV = beautiful voyager, an overthinker who experiences physical symptoms as a result of stress.

The Winging It Spotlight on TWIGG How-To

I'm a big fan of the TWIGG How-to mission: "creating a damsel-free world, one article at a time." The women behind this project reached out and asked if they could reproduce my first piece on GAD, as well as run a short interview. I was honored that they wanted to feature me in their spotlight series. I wrote the piece in order to reach women in their 20s who have anxiety and don't realize it (as I didn't).  Here's the first pull quote they chose to illustrate. It really sums up everything I hoped to do there, and still feel is important here.

Advice and Tips from Readers

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I got so many thoughtful responses to the piece I wrote that I wanted to share them in one place as a resource for others with GAD. They are filled with great advice and support for us all. They shouldn’t just be lost in scraps on my FB wall, in a Slack channel, and on discussion boards.

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Taken from List App

I’m using no names, just quotes. I think it’s interesting there are so many thoughts on this topic, but so little of it happened here on Medium. I think it speaks to the profoundly intimate nature of this topic. We still have far to come as a community and society with being comfortable sharing our experiences with anxiety publicly. I am very grateful to every single person who reached out to me about this piece. Thank you all so much. I know you are going to help everyone who reads this list.

• “Hugs to you, Meredith. I deal with this, too. In case it’s of any help to you: thought-stopping is an incredibly useful tool my shrink gave me. If I start to think about, e.g., the 200 ants in your article, I kindly tell myself, “Nope. Not going there,” and redirect my thoughts (much like distracting a toddler who’s on the brink of meltdown). Gets easier with practice, stops the downward spiral into panic, and has helped me so much. So many of my writer/illustrator friends have anxiety issues — it feels like it may just be part of the creative package.”
• “I’ve been diagnosed with Generalized Anxiety Disorder since I was 17, it is completely possible to live a really kick ass life with this diagnosis. The key is learning about and coming to understanding terms with what GAD means for you and learning how to cope with/disrupt those unhealthy thought patterns. My big suggestion is this, though: If you start to have weird physical symptoms (like the dizziness you describe in your article, I had a flare up of Irritable Bowel Syndrome in my 20s when my first marriage was on the rocks, insomnia or trouble falling asleep is another really common GAD physical symptom) DO NOT WAIT TO GO TO THE DOCTOR. It is likely that what is happening is that you are having general symptoms of GAD that you are either disrupting or ignoring and that because this is a serious anxiety episode, when you ignore/disrupt the mental thinky triggers, your brain says “Okay, mother fucker, you’re not going to pay attention to what I am trying to tell you? Let’s hit your body in other areas, then maybe you’ll stop and take notice. Go to the doctor, get the medication, feel better. THEN deal with the GAD. Sleep and digestion and balance are three areas where those who are diagnosed with GAD often experience physical symptoms, because those are three functions which are critical to operating as a healthy human in the world. Also: Do not let GAD make you feel diminished.Don’t eschew the medication because you think you should be able to control your own worry. You can’t. You shouldn’t try. Those with GAD tend to be high functioning, highly intelligent, successful people — I carry my GAD as a badge of pride of how much I care and how much I think. I think TOO MUCH, so I need a pretty blue pill to make my brain take a nap every now and again. By putting positive terms to it, it makes it much less scary and overwhelming to deal with. I recently had to help a friend (who has a host of other mental illness issues) come to terms with a new GAD diagnosis, I told her It does not make you less than, you are not broken and this is not all in your head. It’s a real problem, with chemical origins and you’re amongst the company of some of the world’s most incredible thinkers and do-ers with a diagnosis of Generalized Anxiety Disorder. /GAD rant.”
• “Great article, thanks! As a fellow GAD-er, I can relate to all this, but I put off getting a formal diagnosis for a long time, assuming that my ‘crazy mom worries’ (i have 2 little ones) were just ‘normal mom worries’. With all the stuff we’re supposed to worry about as moms, it can rapidly start to feel ‘normal’ to lie awake half the night solving hypothetical future problems about the kids’ wellbeing, or lying in the dark worrying about all the bad things that can happen to kids. When i finally started CBT, I told my therapist that i thought my worries were ‘probably pretty normal for a mom’ and she couldn’t stop herself from laughing… because (a) I was wayyyy high on the anxiety spectrum and clearly NOT worrying at normal levels, and (b) the fact that i was working so hard to explain away my worries was contributing massively to my anxiety! About 10 sessions later i’m doing great and have learned lots of different ways to cope. I’d just add that while CBT is awesome and a great therapy for GAD, my psychoanalyst mother would chastise me if I didn’t also note that lots of people have success treating GAD with more traditional ‘talk therapy’ and therapies based in analysis or psychoanalysis. Thanks again for posting about this!”
• “I’ve been dealing with this since I was about 12. It took me until 35 to really get some useful help. Some of what you wrote describes me to a T as a still struggle! Thanks for sharing and here’s hoping we both continue our progress! (My shrink also just recommended The Worry Cure, I guess I ought to actually read it!)”
• “ I’ve struggled with it for about 10 years and there are periods of time it takes over my life and other times it’s much much more managable. This is what helps me, because I don’t have insurance so I can’t work with a therapist on the regular:
  Nutrition (eating a whole foods, plant based diet), meditation (every day, usually for 10–20 minutes, with crystals for a grounding energy), talking about it with trusted friends (naming your demons seem to suddenly make them smaller), laughing about it after (humor is my saving grace), yoga/sun salutations (this helps when the shakiness of an oncoming panic attack looms), drinking tea (not that lipton shit- buy some quality tea), listening to podcasts (duncan trussell, joe rogan, & ram dass for some philosophical/spiritual guidance), abstaining from drinking too much (I work in music so this is a challenge), taking a walk through nature (thank my lucky stars I live next to golden gate park), periodic psychedelic journeys with plant medicines like mushrooms (this one is controversial, but the research that’s being done on psychedelic therapy is fascinating to me — all I can say is do it with someone you trust in a place you feel comfortable & visit www.reset.mefor more info), smoking or eating CBD — This one is important. CBD is a cannabinoid found in cannabis that is NON-psychoactive- meaning, it doesn’t get you “high.” It acts as an anti-psychotic and studies have shown that it even reduces malignant tumors and treats serious pain. The research around CBD is incredible. I work in the medical cannabis industry and have had discussions with people who know their shit and all I can say is that CBD has saved me in so many situations. It’s essentially my xanax nowadays. I don’t trust pharmaceuticals for mental issues anymore because of all the bad experiences I’ve had with them, but CBD is completely safe, natural & your brain even has receptors for this chemical. But, that’s not to say that I don’t enjoy smoking a heavy indica which usually puts me right to sleep so I don’t have to deal with racing thoughts before bed. Working with an energy/reiki healer, reading Chani Nicholas astrological insights, spending time with animals, cleaning/cooking (puts me into a meditative zone and a great time to put on a podcast), and staying away from technology are also other great tools too.
  This was a novel, but I’m not sorry. All of these things keep me sane when it seems like all my mind wants to do is go there. Hope this helps!!You’re not alone.”
• “Words that I live by courtesy of my therapist: there is no shame in getting the help you need to learn to cope and live a balanced and full life. It’s much like entering AA: the first step to feeling better is admitting you need help doing it. I used to be ashamed of my GAD because I thought it made me weak. Now I’m open and honest about it. If you’re not willing to deal with my idiosyncrasies, you can get out of my life…”
• “Thanks for writing! I was diagnosed with GAD back in 2010 and it took me a few years to even believe it was a “real” thing because it sounded so… general. I’ve never talked about it publicly because of the stigma and I’m not really sure what to say about it. CBT helped a lot, but it’s hard to explain to people that some of the reasons I’m successful are also reasons I have a hard time with certain interactions…What I’ve gotten from talking to professionals is that anxiety doesn’t really “help” [us] and that the fear is unfounded. You can have your benefits without having the stressful feeling of the anxiety. I’ve definitely gotten better over time, but it ebbs/flows. I’ve also realized there’s some underlying stuff for me (For example — I’ll have nightmares and that will make me anxious, but I’ll assume it must be attributed to real life and spend a lot of time overanalyzing what it is). I often just need a way to ask people if I’m being reasonable or am totally off base — I’ve sort of outsourced it to a lot of diff people for diff issues, and that works well enough. A support group would be an easier way to do it all the time and give someone a more consistent view.”
• “Great piece Meredith! It is helpful to understand and to help others to do so. The feelings of not being enough are so woven into the fabric of everyday that it is hard to see how corrosive this can be. That’s the whole reason I had to learn how to stop and give praise and gratitude for every little action. Staying rooted in the present, taking small steps, seeing these feelings as feelings, surrounding oneself with kind loving people, doing something each day that brings pleasure helps so much. It is a process and a daily practice.”
• “Wow, I have no doubt it took so much courage to write that. I’m a fan of cognitive behavioral therapy. A friend of mine gave me a copy (almost 15 years ago!) of David Burns’ “Feeling Good Handbook” and it was quite eye-opening. If you find the book itself helpful, you may want to try the Handbook because it’s a workbook that you fill in as you read. That helped me a lot personally because I had trouble translating the theory to action without something concrete to work on. Have you seen Allison Vesterfelt’s blog? This post of hers may be of interest to you: http://allisonvesterfelt.com/mind-body-connection/ I don’t know if what she’s wrestling with is GAD, but I have been following her blog the past couple of months.“
• “wow, such a brave, honest, and insightful piece. I especially love the use of q&a. You come across as an authority on the subject of GAD, but you also maintain the vulnerability of someone who’s still learning about it. I like that. It’s making me want to put fingers to keyboard on things I’ve wanted to write about that others could benefit from. Your thoughtfully written personal experience will do more for people than any impersonal “info” site. Thanks for sharing!”
• “As someone who suffers from chronic anxiety and panic attacks, I relate to the GAD struggles. My challenge continues to be my inability to identify (every time) my triggers. For example last night I was driving home from the movies and had a panic attack for seemingly no reason- I had seen The Intern w a bestie and was in a great place. Blurred vision and sweats to the point I had to pull over on the 10. I’ve been in therapy since I was 6 and tried traditional and alternative medications to no avail, so have been working on meditation, diet, regular workouts and being kind & patient to myself and grateful for all that I have! Thank you everyone for sharing, it does help knowing you’re not in this alone.For me, I constantly remind myself to be forgiving, understanding, patient and push myself to live comfortably in the discomfort. It goes in waves, but I’m healthy and will either live through it or overcome!! If anyone has any recommendations (meds, diet, books or alternative solutions) love your thoughts! Thanks!”
• “I think that so many of us PMs (Product Managers) have persistent anxiety due to the nature of the job. With our minds and work in many places, with many different people, and often in a time crunch, I see a lot of anxiety in PMs that goes well beyond the workday into our personal lives and evenings with family. I’ve seen anxious PMs day in and day out. I agree it’s almost like an anxiety junkie situation, and a desire to make order out of chaos, and perhaps it is a perfect role for us anxious types because our minds go a mile a minute, but I think that you have emphasized a serious issue and that anxiety in PM careers needs to be addressed and dealt with. And, perhaps, it could mean a responsibility shift in some arenas to remedy the situation. It’s profound that you shared your experience, and can encourage women (especially me!) to address issues before they get out of hand.”
• “I was just recently diagnosed, and it’s been an uphill battle. I don’t think I would have sought an answer had I not broken up with my long term boyfriend for fear that eventually he would leave me. Then I had to stop and say “what the hell is wrong?” I’ve been seeing a therapist and working with my doctor, and I’ve noticed such a difference since I’ve been able to identify what it is exactly I’m going through. I don’t remember the last time I really felt at ease. And my goal is to get back to a point where I can, and enjoy my life more. Thank you thank you thank you for what you wrote!!!”

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From FB, liked 8 times

I will edit and add to this list as I get more responses in! 

You are not alone, out there.